Heypresto!

Well at least that’s what the newspaper headline said! Our youngest Wolfhound, Presto (Heliodor Heypresto at Midnitecove) recently found himself in a predicament with his right knee and after a short period of intermittent lameness and exploratory examination and X-rays, he was diagnosed with cruciate ligament disease (often also referred to as spontaneous.
Many breeds can suffer with knee issues and certainly the condition is not confined to giant breeds, but, as with many other aspects of giant breed ownership, a dog weighing over 80kg presents its own unique challenges in terms of treatment options and long term management. These days we are fortunate to have quite an array of surgical interventions available to treat cruciate ligament issues and the options fall into 2 main camps; those surgeries that seek to replace the failing ligament with a suture technique and also surgeries that aim to stabilise the knee by inserting different types of metalwork. Most orthopaedic vets tend to prefer the stabilisation techniques on larger dogs as they are generally stronger and less likely to encounter problems, considering the weight the knee carries and also the forces exerted on that joint. With Presto the operating vet (Mr Graham Oliver of East Midlands Referrals, Nottingham) opted for a TTA technique (Tibial Tuberosity Advancement), which involves cutting vertically into the tibial bone and inserting a metal wedge, which then advances the front of the tibia to prevent the femur slipping off. Once the wedge insert is in place, a metal plate is screwed into the two parts of the tibia to stabilise the bone and prevent splintering. Therefore the TTA procedure has always comprised of these two stages and needed both the metal insert and the stabilising plate.

A few months ago, thanks to advances in technology, a modified form of the TTA became available, where the metal insert and plate have effectively become combined into one item. The new invention is referred to as a ‘Rapid Cage’ and is made of titanium and is manufactured by means of printing on a 3D laser printer. Without the 3D printer this amazing new gadget would not be possible to manufacture, due to its intricacy and in particular, the fine metal meshwork/honeycomb that enables the dog’s own bone to grow into the insert and become a very strong fix. Not only does the Rapid Cage act as an insert to wedge the tibia and advance the front crest of the bone, but it also has integrated screw holes which enable the cage to be screwed into both sections of the tibia and therefore eliminating the requirement for an additional stabilising plate. In addition, the titanium and the honeycomb structure are biocompatible with the dog’s bone and aid a faster recovery and a far more stable, stronger and sustainable result. The recovery time after this type of procedure is still fairly lengthy, before the dog is able to return to full exercise and certainly for the first 4 weeks the dog should be restricted to the garden and not permitted to climb or jump onto, or down from, other surfaces. However, the dog is expected to be standing almost immediately after surgery and also independently mobile within 24 hours of the procedure. Often the dog owner has more issues in stopping their pet from overdoing it, rather than struggling to assist their dog to bear weight or walk. After the first month post-op, the dog can be exercised, starting very gently with 5 minute lead walks, three times a day and then gradually building up to longer walks. Once the bone has healed and the knee has stabilised then the joint should be almost as good as new, but the knee will be permanently bent and forward extension of that hind leg will not be possible. This surgical procedure certainly does not prevent the dog leading a happy and active life, able to walk and run and without such intervention, the prognosis for any giant breed with a failing cruciate ligament would be very limited, not only in terms of activities, but also in terms of duration.